Each year in the United States there are approximately 160,000 live births to women 35 years of age and above. The empirical risk for giving birth to a child with Down syndrome rises from 1/365 at age 35 to 1/32 at age 45. While amniocentesis for prenatal diagnosis of Down syndrome is now accepted medical practice, one study estimates that only 5 to 6 percent of American pregnant women in this age group are currently being evaluated by amniocentesis. This "underutilization," as it has been termed by researchers, is a complex public health problem. Studies of utilization are sparse; a handful of investigators has provided information primarily on the demographic characteristics of women undergoing amniocentesis. None of the studies has explored the range of factors - demographic, psychosocial, organizational and behavioral - which may influence utilization. The effect of these factors on amniocentesis utilization can best be understood when all four categories of factors are examined in one study population. The purpose of the research proposed is to begin to fill the gap in the knowledge of factors affecting amniocentesis utilization. Self-administered questionnaires will be completed during the postpartum hospital stay by all women (approximately 330) age 35 and over who deliver normal infants at an urban university teaching hospital during a seven month period. This retrospective cross sectional study is the first U.S. study to survey women who should have been referred for amniocentesis and were not referred, as well as women who sought prenatal care too late in the pregnancy to be referred. Information will be collected on demographic characteristics, psychosocial factors including knowledge of and attitudes about amniocentesis, the organization of prenatal care, and individual and provider health related behavior. A record study will be conducted to validate self report data provided on the questionnaire. The results of this study will provide information for health policymakers, health care administrators, health care providers and health educators who seek to understand and to facilitate amniocentesis utilization.